Increased survival among HIV-infected persons in the era of effective combination antiretroviral therapy and growing rates of new HIV diagnoses among older adults have resulted in growing numbers of older people living with HIV disease. At the same time, cardiovascular disease (CVD) has emerged as a major contributor to non-AIDS related illness and death among HIV-infected patients. Cumulative evidence suggests that HIV infection itself, as well as the antiretroviral medications used in its treatment, may contribute t increased CVD risk. In order to adequately manage their CVD risk as well as HIV disease, patients need to be able to correctly interpret the information provided to them about risk, a task that requires considerable skill in both health literacy and numeracy. Inadequate health literacy is a major barrier to effective health care in the U.S. and has been highlighted by the Institute o Medicine as a national priority. Poor health literacy is particularly prevalent among low-income and minority groups, groups that are over-represented in the HIV-infected population, and studies of health literacy among people living with HIV infection have reported inadequate or marginal health literacy in 25 - 30% of HIV-infected adults. Existing data offer evidence that low health literacy is associated with less knowledge about HIV and, in the general population both low health literacy and low numeracy have been associated with poorer control of major CVD risk factors. Relationships between literacy and health outcomes may be modified by patients' health beliefs. The beliefs that people living with HIV have about the benefits of CVD risk reduction are likely to be affected by their views on how HIV disease has affected their life expectancy. Growing evidence suggests that people diagnosed with HIV infection in industrialized countries during the current era of combination antiretroviral therapy have a life-expectancy approaching that of their uninfected peers. Recent data show non-AIDS clinical events to be a more frequent cause of death than AIDS-related illness among HIV-infected populations in this era, with CVD being among the leading causes of non-AIDS-related death. Although these data have been widely disseminated among HIV care providers, it is likely that many people living with HIV remain unaware of these findings. Additionally, beyond individual-level factors, contextual factors often affect the ability of at-risk populations to follow measure to modify CVD risk. This study will use a mixed methods approach to examine the roles that health literacy and numeracy, contextual factors, patients' perception of their life expectancy in the setting of HIV disease, and perceptions about facilitators and barriers to CVD risk management, play in cardiovascular risk among HIV-infected adults. The data collected in this study will inform our development of an intervention for improving the management of CVD risk in this vulnerable population. PUBLIC HEALTH RELEVANCE: As advances in antiretroviral treatment of HIV disease have led to increased survival among people living with HIV, cardiovascular disease (CVD) has emerged as a major contributor to non-AIDS related illness and death among HIV-infected patients. This study will examine the roles that health literacy and numeracy, patients' perception of their life expectancy in the setting of HIV disease, contextual factors, and perceptions about facilitators and barriers to CVD risk management play in cardiovascular risk among HIV-infected adults. The data collected in this study will inform our development of an intervention for improving the management of CVD risk in this vulnerable population.